MH AND ADVERSE SELECTION IN MANAGED CARE

许多人认为，由于心理健康成本与其他服务成本的相关性，精神健康服务供应不足将是管理式医疗计划将采用的一种策略，以阻止失败的参保者，但这种论点从未受到实证审查。在管理式护理中，精神卫生服务比其他疾病的治疗更有可能不足吗？拟议的研究将通过确定在管理式医疗中，哪些疾病的治疗最受选择激励的影响来解决这个问题。我们对心理健康特别感兴趣，但我们认为，提供心理健康护理的激励措施与其他服务的激励措施是相关联的。这一建议引入了一种基于经济理论的新方法，以得出服务配给计划严格程度的度量。我们展示了如何将这一措施用作在各种条件下过度和不足提供服务的激励的计算上的直接指数。本研究拟对这一概念进行实证研究，并根据研究结果，对管理式医疗计划中风险调整政策和“分割”机制提出具体建议，以应对与选择相关的激励机制。由选择相关激励产生的服务扭曲影响了参保人的计划选择。通过将精神健康护理从健康计划的竞争策略中移除，“开拓计划”可能会削弱这种激励。我们检验了这种效应的经验重要性。逆向选择是对保险市场提供精神卫生保健效率的持久威胁。了解逆向选择在管理式医疗中是如何起作用的，以及对此可以做些什么，应该是研究的重中之重。

Many believe that underprovision of mental health services will be one strategy managed care plans will adopt to discourage loser enrollees because of the correlation of mental health costs with costs of other services, but this contention has never been subject to empirical scrutiny. Are mental health services any more likely to be under-provided in managed care than treatments for other conditions? The proposed research would address this question by identifying the conditions whose treatments are most affected by selection incentives in managed care. We are particularly interested in mental health, but we consider the incentives to provide care for mental health in relation to the incentives for other services. This proposal introduces a new approach, based on economic theory, to derive a measure of plan strictness in rationing of services. We show how this measure can be used as a computationally straightforward index of incentives to over and under-provide services for various conditions. We intend to empirically implement this concept in this research, and based on the results, make concrete recommendations for policies of risk adjustment and "carve outs" for dealing with selection-related incentives in markers for managed care plans. Service distortions generated by selection-related incentives affect the plan choices of enrollees. Carve out programs may attenuate such incentives by removing the mental health care from the competitive strategy of health plans. We test the empirical importance of this effect. Adverse selection is a enduring threat to the efficiency of provision of mental health care in insurance markets. Understanding how adverse selection works in managed care and what can be done about it should be a very high priority for research.